AB1725-PARE SEQUENCE PATIENT SURVEY: PERCEPTION OF THE USE OF ADVANCED THERAPIES FOR PSORIATIC ARTHRITIS IN THE UNITED KINGDOM
Authors: C. Gollins, A. Vivekanantham, M. Brooke, L. Coates, W. Tillett
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Due to the chronic nature of psoriatic arthritis (PsA) and the increase in therapeutic options, many people are receiving multiple sequential lines of biologic and targeted synthetic disease modifying anti-rheumatic drugs (b/tsDMARDs). There is limited data on treatment response to advanced lines of therapy and therefore in the rationed UK National Health Service, some regions are limited in the number of sequential b/tsDMARD per patient. Patients have higher levels of treatment satisfaction with biologics compared to conventional DMARDs<sup>[1]</sup> but little is known about patient satisfaction with access to b/tsDMARDS in the UK. <h3>Objectives</h3> To assess the perceptions of people treated with b/tsDMARDS in the UK for PsA, focusing on the experience of access to advanced treatments. <h3>Methods</h3> The cross-sectional SEQUENCE patient survey was developed as an anonymous online questionnaire on the SurveyMonkey platform, available to be completed by people with self-reported PsA and current or previous b/tsDMARD treatment. The freely available online survey was promoted through PsA support groups via websites and social media. Descriptive analysis of the results was performed, with categorical variables summarised with frequencies and percentages. <h3>Results</h3> 67 people from England, Wales and Scotland responded (male 8, female 59), mean age 54.5 years, mean psoriasis duration 22 years (range 0-55) and PsA 14 years (range 1-50). The number of lines of previous b/tsDMARD treatment per respondent is outlined in Fig 1. The most common first line treatments were adalimumab (33/60) or etanercept (12/60) with secukinumab the most common second line drug (15/42). Switching treatments was most commonly due to primary or secondary failure. 46.7% (28/60) of people felt that a decision to switch treatment had been a joint decision between patient and physician. Only 9% (6/67) had been advised that there was a maximum number of biologics permitted in their region. 24% (16/66) had been advised that a particular b/tsDMARD had to be prescribed first line for PsA in their region, 76% (13/17) of whom reported this was a TNF inhibitor. One respondent had to move hospital or region to obtain access to further biologics. 32% (21/65) had been told that an individual funding request had been applied for to fund their next b/tsDMARD (likely due to limited funded treatment options), and this was successful for 90% (20/23). Qualitative responses highlighted the significant improvement that b/tsDMARDs make to people with PsA e.g. 'They have given me my life back'. However, there was frustration towards perceived delays in access: 'We should not need to suffer cDMARDS and fail, losing months of our lives, to get to a biologic.' <h3>Conclusion</h3> Within this UK PsA population, a minority reported limitations on the class or line of b/tsDMARD available in their region. There was an overall positive response to treatment with biologics, and perception of access generally. However, when patients have difficulty accessing later lines of treatment, it has an adverse effect on their lives. The small proportion of respondents who have had difficulty with access suggests that the overall cost of creating equitable access to b/tsDMARDs in the UK may be relatively low but would have a meaningful impact. <h3>Reference</h3> [1]K.S. Tveit, A. Duvetorp, M. Østergaard et al. Treatment use and satisfaction among patients with psoriasis and psoriatic arthritis: results from the NORdic PAtient survey of Psoriasis and Psoriatic arthritis (NORPAPP). J Eur Acad Dermatol Venerol. 2019: 33, 340–354 <h3>Acknowledgements</h3> Thank you to the British Psoriatic Arthritis Consortium (Brit-PACT) for help with development of the survey and to Brit-PACT, the Psoriasis Association and Andrea Jack for promotion of the online survey. <h3>Disclosure of Interests</h3> Charlotte Gollins: None declared, Arani Vivekanantham: None declared, Mel Brooke: None declared, Laura Coates Speakers bureau: has been paid as a speaker for AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Medac, Novartis, Pfizer and UCB., Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Moonlake, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer and UCB, William Tillett Speakers bureau: Abbvie, Amgen, Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Consultant of: Abbvie, Amgen, Eli Lilly, GSK, Janssen, Novartis, Ono Pharma, Pfizer, UCB, Grant/research support from: Janssen, UCB, Pfizer, Eli-Lilly.